SummaryBackground Surgical site infections (SSIs) are a leading and preventable cause of postoperative morbidity in Pakistan. However, the absence of national-level data has precluded the development of targeted preventative measures. PakSurg1 aimed to quantify the burden of SSIs and evaluate associated risk factors in a multicentre cohort across Pakistan. Methods We conducted a prospective cohort study of 1711 patients across 28 hospitals in Pakistan from 2022 to 2023. Adult patients undergoing elective general or subspecialty surgery were followed for 30 days postoperatively. We assessed SSI incidence and identified risk factors at the patient, surgical, and hospital levels. Findings The overall incidence of SSIs was 9.5% (n = 163). Most SSIs were superficial (73.6%; n=120) and managed non-surgically with antibiotics (66.9%; n=109). On multivariable analysis, SSIs were more likely in patients undergoing trauma-related surgery (OR: 3.047 95% CI: 1.205–7.708), with contaminated or dirty wounds (OR: 3.245 95% CI: 1.298–8.113), or with longer hospital stays (OR: 1.068 95% CI: 1.036–1.101). Several modifiable factors were associated with lower odds of SSI. These included laparoscopic surgery (OR: 0.556 95% CI: 0.343–0.900), ambulatory procedures (OR: 0.598 95% CI: 0.375–0.953), combined chlorhexidine and povidone-iodine skin preparation (OR: 0.304 95% CI: 0.131–0.704), and completion of a surgical time-out (OR: 0.446 95% CI: 0.268–0.743). Compared to general surgery, lower SSI odds were observed in cardiac (OR: 0.223 95% CI: 0.074–0.672), cranio-spinal (OR: 0.292 95% CI: 0.126–0.676), and orthopaedic (OR: 0.216 95% CI: 0.071–0.655) procedures. Interpretation PakSurg 1 provides a national estimate of SSI incidence in elective surgeries in Pakistan and identifies key, modifiable risk factors. These findings can inform targeted, context-specific strategies to reduce SSIs and improve surgical safety nationwide. Funding This study received monetary funding from the Student & Trainee Initiated Research Program (MBBS Class of '88 Awards, Aga Khan University, Karachi, Pakistan).
Waqar et al. (Mon,) studied this question.